Gluteal Region And Thigh Flashcards
Gluteal region
. Post. To pelvis
. Boundaries: iliac crest sup., greater trochanter lat., and gluteal fold inf.
Thigh region boundaries
. Btw hip and knee
. Ant: inguinal ligament
. Post.: gluteal fold
Fascia lata attachments and function
.deep fascia of gluteal region and thigh
. Ant.: fuses w/ inguinal ligament and attaches to pubis
. Lat. and post.: iliac crest, ischial tuberosity, and sacrum
. Inf.: femur and tibia at knee
. Continuous w/ crural fascia
. Encloses gluteus Maximus and tensor fascia latae mm. To help stabilize knee
Saphenous opening
. Superomedial thigh lat. to pubic tubercle
. Transmits blood and lymphatic vessels
Iliotibial band
. Lat. thickening of fascia lata
. Attachments: iliac tubercle sup., lat. tibial (Gerry) tubercle inf.
Intermuscular septa
. Deep extensions attaching the fascia lata to femur
. Lat. intermuscular septum well defined and attached to iliotibial tract to linea aspera and lat. supracondylar line
. Med. and post. Intermuscular septa poorly defined, attach to med. linea aspera
Compartments of thigh
. Ant: flexors of hip and extensors of leg
. Med.: adductors of thigh
. Post.: extensors of thigh and flexors of leg
Tensor fasciae latae m. OIAN
O: Iliac crest and anterior superior iliac spine (ASIS)
I: Iliotibial tract and Gerdy tubercle
A: Flexes, abducts, medially rotates thigh; stabilizes extended knee
N: Superior gluteal n.
Gluteus Maximus OIAN
O: Post. ilium surface; dorsal sacrum, coccyx, and sacrotuberous lig.
I: Iliotibial tract and Gerdy tubercle; gluteal tuberosity of femur
A: Extends, laterally rotates thigh; stabilizes torso; assists standing from
seated position
N: Inferior gluteal n.
Gluteus medius OIAN
O: Anterosuperior ilium surface
I: Greater trochanter of femur
A: Abducts, medially rotates thigh; stabilizes pelvis in one-legged stance
N: Superior gluteal n.
Gluteus minimums OIAN
O: Anteroinferior ilium surface
I: Greater trochanter of femur
A: Abducts, medially rotates thigh; stabilizes pelvis in one-legged stance
N: Superior gluteal n.
Gluteus muscle use while walking
. Maximus counteracts forward momentum of torso
. Medius and minimus prevent pelvic tilt when contralateral leg is lifted
Piriformis m. OIAN
O: Ventral sacrum w/in pelvis and greater sciatic notch margin
I: Greater trochanter of femur (via greater sciatic foramen)
A: Laterally rotates thigh; abducts flexed thigh
N: Nerve to piriformis (S1-S2
Obturator internus m. OIAN
O: Pelvic surface of obturator membrane
I: Greater trochanter of femur (via lesser sciatic foramen)
A: Laterally rotates thigh; abducts flexed thigh
N: Nerve to obturator internus (L5-S1)
Superior gemellus m. OIAN
O: Ischial spine
I: Greater trochanter of femur via tendon of obturator internus
A: Laterally rotates thigh; abducts flexed thigh
N: Nerve to obturator internus (L5-S1)
Inferior gemellus OIAN
O: Ischial tuberosity
I: Greater trochanter of femur via tendon of
obturator internus
A: Laterally rotates thigh; abducts flexed thigh
N: Nerve to quadratus femoris (L5-S1)
Quadratus femoris m. OIAN
O: Ischial tuberosity
I: Quadrate tubercle of intertrochanteric crest
A: Laterally rotates thigh
N: Nerve to quadratus femoris (L5-S1)
Trochanteric bursa
. Separates gluteus Maximus from greater trochanter of femur
Ischial bursa
. Separates gluteus Maximus from ischial tuberosity
Trochanteric bursitis
. Pain over greater trochanter that radiates to IT tract when climbing stairs or rising from seated position
Ischial bursitis (Weaver’s bottom)
. . Caused be extended sitting on hard surfaces
. Coupled w/ repetitive lower limb movements
Gluteal region branches of sacral plexus
. Sup. And inf. Gluteal nn. . Sciatic n. . Post. Femoral cutaneous n. . Pudendal n. . Minor muscular nn.
Sup. Gluteal n.
. L4-S1
. Exits greater sciatic foramen sup. To piriformis
. Courses and ratifies in plane btw gluteus medius and minimus
Inf. Gluteal n.
. L5-S2
. Exits greater sciatic foramen inf. To piriformis
. Branches enter deep surface of Maximus
Sciatic n.
. L4-S3
. Exits greater sciatic foramen inf. To piriformis
. Courses inf. And deep to Maximus, sup. To obturator internus, gemellus, and quad femoris
. Lat. to ischial tuberosity
. Tibial division: from ant. Divisions of sacral plexus
. Common fibular division: from post. Divisions of sacral plexus
. Divides in popliteal fossa
Posterior femoral cutaneous n.
. S2-3
. Course similar to sciatic n.
. Emerges inf. To Maximus and descends in post. Thigh deep to fascia lata
. Supplies inf. Cluneal nn. To the skin of butt
Cutaneous innervation of gluteal region
. Cluneal branches of dorsal primary rami (L1-S3)
. Post. Femoral cutaneous n.
Superior gluteal a.
. Branch of post. Division of internal iliac a.
. Accompanies sup. Gluteal n.
. Supplies Maximus, medius, minimus, and tensor fasciae latae
Inferior gluteal a.
. Branch of ant. Division of internal iliac a.
. Accompanies inf. Gluteal n.
. Anastomoses w. Sup. Gluteal a.
. Supplies maximus, lat. rotators, and upper hamstring mm.
Lymph for gluteal region
. Deep structures drain to internal iliac nodes
. Superficial tissues drain to superficial inguinal nodes
Gluteus maximus gait
. Damage to inf. Gluteal n.
. Causes weakness of hip extension
. Tendency of torso to collapse forward (jack-knife)
. When walking, exaggerated torso extension during heel-strike on affected side maintains balance
Gluteal safe area
. Superolateral quadrant of butt
. When injections go to prevent damage to nn. And vessels in butt
Piriformis syndrome
. Compression of sciatic n. By piriformis
. Causes dull butt pain that radiates to post. Thigh, leg, and foot
Muscles in posterior compartment of thigh
. Semitendinosus
. Semimembranosus
. Biceps femoris long and short heads
Semitendinosus m. OIAN
O: Ischial tuberosity
I: Medial surface of superior tibia
A: Extends thigh, flexes and medially rotates leg
N: Tibial division of sciatic nerve
Semimembranosus
O: Ischial tuberosity
I: Medial condyle of tibia
A: Extends thigh, flexes and medially rotates leg
N: Tibial division of sciatic nerve
Biceps femoris long head OIAN
O: Ischial tuberosity
I: Head of fibula
A: Extends thigh, flexes and laterally rotates leg
N: Tibial division of sciatic nerve
Biceps femoris short head OIAN
O: Linea aspera
I: Head of fibula
A: Flexes and laterally rotates leg
N: Common fibular division of sciatic nerve
Hamstring injuries are most common in what sports?
. Runners
. Cutting sports
Muscles in anterior compartment of thigh
. Pectineus
. Iliopsoas
. Sartorius
. Quad femoris
Pectineus OIAN
O: Superior pubic ramus
I: Pectineal line of femur
A: Flexes, adducts, and medially rotates thigh
N: Femoral n., obturator n. (variable)
Iliopsoas m. OIAN
O: psoas major and iliacus come together
I: lesser trochanter
A: Flexes thigh
N: L1-L3 fibers, directly and via femoral n.
Sartorius m. OIAN
O: Anterior superior iliac spine
I: Medial surface of superior tibia
A: Flexes, abducts, and laterally rotates thigh, Flexes and medially rotates leg
N: Femoral n.
Quadriceps femoris
. 4 muscle bellies attached to patella via quadriceps tendon and indirectly to tibial tuberosity via patellar ligament
. A: Extends leg (rec femoris flexes thigh)
. N: femoral n.
. Rectus femoris O: AIIS
. Vastus lateralis O: greater trochanter and lineman aspera
. Vastus medialis O: intertrochanteric line and linea aspera
. Vastus intermedius O: ant. And lat. femoral shaft
Suprapatellar bursa
. Sup. Extension of synovial membrane of the knee
. Seep to quad femoris tendon
. Deep fibers of vastus intermedius pull it sup. To prevent entrapment during knee extension
Patellar tendon reflex
. Tests L2-4 segments and femoral n.
Muscles in medial compartment of thigh
. Gracilis . Adductor longus . Adductor brevis . Adductor magnus . Obturator externus
Gracilis m. OIAN
O: Body and inferior ramus of pubis
I: Medial surface of superior tibia
A: Adducts thigh, flexes and medially rotates leg
N: Obturator n.
. Can be used to replace injured muscle for breast reconstruction
Pes anserinus
. Tendons of sartorius, semitendinosus, and gracilis
. Associated w/ anserine bursa
Anserine bursitis
. Common cause of medial knee pain
Adductor longus OIAN
Origin: Body of pubis
Insertion: Linea aspera
Action: Adducts thigh
Innervation: Obturator n.
Adductor brevis OIAN
Origin: Body and inferior ramus of pubis
Insertion: Linea aspera
Action: Adducts thigh
Innervation: Obturator n.
Adductor magnus puofemoral portion OIAN
O: Inferior pubic ramus
I: Gluteal tuberosity, linea aspera, medial supracondylar line
A: Adducts and flexes thigh
N: Obturator n.
Adductor magnus ischiocondylar portion OIAN
Origin: Ischial tuberosity
Insertion: Adductor tubercle
Action: Extends thigh
Innervation: Tibial division of sciatic n.
Obturator externus m. OIAN
Origin: External surface of obturator membrane and adjacent pelvis
Insertion: Trochanteric fossa of femur
Action: Laterally rotates thigh
Innervation: Obturator n.
Obturator n.
. Anterior divisions of L2-4
. Exits pelvis via obturator canal
. Divides into ant. And post. Branches that sandwich adductor brevis
. Innervates med. compartment mm. And pectineus
. Cutaneous branch supplies small region on superomedial thigh
Femoral n.
. L2-4 posterior division
. Exits abdomen inf. To inguinal ligament
. Gives muscular branches to ant. Compartment mm.
. Ant. Femoral cutaneous branches supply skin of ant. Thigh
. Terminal cutaneous branch is saphenous n. Supplies anteromedial knee, leg, and foot
Lateral femoral cutaneous n.
. Exits abdomen inf. To inguinal ligament med. to ASIS
. Supplies skin of lat. thigh
. L2-3
Post. Femoral cutaneous n.
. S2-3
. Descends in post. Thigh deep to fascia lata
. Supplies skin of post. Thigh and popliteal fossa
Meralgia paresthetica
. Tingling/burning pain in upper lat. thigh
. Caused by compression of lat. femoral cutaneous n.
. Pregnancy, obesity, and restrictive clothing are common causes
Femoral a.
. Continuation of external iliac a. Distal to inguinal ligament
. Exits abdomen inf. To inguinal ligament and med. to femoral n.
. Courses inf. Through femoral triangle and adductor canal
. Passes through adductor magnus hiatus then becomes popliteal a.
. Supplies mm. Of ant. And med. compartments
. Gives rise to deep femoral a.
Deep femoral a.
. Supplies post. Compartment
. Courses inf. And deep to adductor longus
. Branches: medial circumflex femoral a., lat. femoral circumflex a., and perforating aa.
Medial circumflex femoral a.
. Courses post. Btw pectineus and iliopsoas
. Supplies head and neck of femur
. Contributed to cruciate anastomosis
Lat. femoral circumflex a.
. Courses lat. deep to rectus femoris m.
. Supplies ant. Gluteal mm. And contributes to cruciate and genicular anastomoses of hip and knee
Perforating aa. Branches from deep femoral a.
. Pierce adductor magnus tendon
. Supplies adductor magnus and post. Compartment mm.
Obturator a.
. Accompanies obturator n. Through obturator canal
. Ant. And post. Branches accompany obturator n.
. Supplies med. compartment muscles and head of femur via acetabulum branch
Femoral v.
. Continuation of popliteal vv. As it transits adductor hiatus
. Becomes external iliac at inguinal ligament
. Ascends in adductor canal post. To femoral a.
. Receives deep femoral and great saphenous vv. And courses inf. To inguinal ligament med. to femoral a.
What vein is commonly harvested for use in vascular graft procedures?
Great saphenous v.
Femoral triangle
. Triangular depression in superomedial thigh bounded by inguinal ligament (base), sartorius and adductor longus (meet to make apex)
. Iliopsoas and pectineus: v-shaped floor
. Fasciae lata: roof
. Contents from lat. to med.: femoral n., a., v., deep inguinal lymph nodes (NAVL)
Femoral sheath
. Funeral shaped prolongation of transversalis and iliacus fasciae surrounding femoral vessels
. Does NOT enclose femoral n.
. CT septa divide sheath into 3 vertical compartments: Lat (femoral a.), intermediate (femoral v.), and med (lymph vessels, deep inguinal nodes)
Femoral canal
. Medial compartment of femoral sheath
. Proximal opening is called femoral ring and it bounded med. by lacunar ligament and lat. by compartment septum
. Site of femoral hernias
Adductor (subsartorial) canal
. Bounded lat. by vastus medialis, med. by sartorius, and post. By adductor longus/magnus
. Transmits femoral a./v. And branches of femoral n. Including saphenous n.
